| 血小板与淋巴细胞比率、脂蛋白相关磷脂酶A2及同型半胱氨酸与缺血性卒中诊断
和短期预后的关系 |
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| 引用本文： | 陈璐,黄小雨,刘洁,肖成华,王炎强.血小板与淋巴细胞比率、脂蛋白相关磷脂酶A2及同型半胱氨酸与缺血性卒中诊断
和短期预后的关系[J].神经疾病与精神卫生,2020,20(2):89-96,F0003. |
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| 作者姓名： | 陈璐 黄小雨 刘洁 肖成华 王炎强 |
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| 作者单位： | 221004 徐州医科大学临床学院;221002 徐州医科大学附属医院神经内科;261031 潍坊医学院附属医院神经内科 |
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| 基金项目： | 国家自然基金科学项目（81870943） |
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| 摘 要： | 目的探讨血小板与淋巴细胞比率(PLR)、脂蛋白相关磷脂酶A2(Lp-PLA2)、同型半胱氨酸(HCY)水平与缺血性卒中诊断、短期预后的关系。方法回顾性连续纳入2018年10月至2019年10月徐州医科大学附属医院神经内一科收治的200例缺血性卒中患者(病例组),以同期体检的健康人群120例作为对照组,分别检测PLR、Lp-PLA2及HCY水平。病例组患者入院时根据美国国立卫生研究院卒中量表(NIHSS)评分分为轻、中、重度神经功能缺损组;治疗3周后根据改良Rankin量表(mRS)评分将病例组患者分为预后良好与预后不良组。分别比较病例组轻、中、重度神经功能缺损患者以及预后良好与预后不良组患者的血清PLR、Lp-PLA2、HCY水平,并绘制受试者工作特征(ROC)曲线分析其诊断效能,评价预后价值。结果与对照组比较,病例组患者血清PLR、Lp-PLA2及HCY水平显著升高分别为(168.73±62.12)比(116.87±31.87),(245.64±81.30)μg/L比(165.17±38.13)μg/L,(18.45±6.81)μmol/L比(11.14±3.04)μmol/L],差异均有统计学意义(t值分别为9.843、11.377、13.161,均P<0.05)。二元Logistic回归分析结果显示,血清PLR、Lp-PLA2、HCY为缺血性卒中的独立危险因子(OR值分别为1.017、1.005、1.072,95%CI分别为1.009~1.026、1.000~1.010、1.009~1.139;均P<0.01)。轻、中、重度神经功能缺损组中血清PLR、Lp-PLA2及HCY水平两两比较差异均有统计学意义(均P<0.01)。出院3周后随访结果显示,预后不良组中血清PLR、Lp-PLA2、HCY水平明显高于预后良好组分别为(204.75±65.08)比(140.43±41.97),(282.99±77.49)μg/L比(216.29±71.89)μg/L,(21.76±7.02)μmol/L比(15.86±5.40)μmol/L],差异均有统计学意义(t值分别为8.048、6.293、6.716,均P<0.05)。血清PLR、Lp-PLA2、HCY及三者联合诊断缺血性卒中曲线下面积分别为0.768、0.823、0.855、0.879(均P<0.01)。血清PLR、Lp-PLA2、HCY预测病例组短期预后的ROC曲线下面积分别为0.803、0.796、0.788。结论血清PLR、Lp-PLA2及HCY水平在缺血性卒中患者升高显著,联合检测具有较高的诊断效能,较好的临床预后评估价值,可成为早期预测缺血性卒中发生的生物学指标。
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| 关 键 词： | 缺血性卒中 血小板与淋巴细胞比率 脂蛋白相关磷脂酶A2 同型半胱氨酸 预后 |
Study of the relationship between platelet to lymphocyte ratio,lipoprotein-associated phospholipase A2,homocysteine,and the diagnosis and short-term prognosis of ischemic stroke |
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| Chen Lu,Huang Xiaoyu,Liu Jie,Xiao Chenghu,Wang Yanqiang.Study of the relationship between platelet to lymphocyte ratio,lipoprotein-associated phospholipase A2,homocysteine,and the diagnosis and short-term prognosis of ischemic stroke[J].Nervous Diseases and Mental Health,2020,20(2):89-96,F0003. |
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| Authors: | Chen Lu Huang Xiaoyu Liu Jie Xiao Chenghu Wang Yanqiang |
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| Affiliation: | (School of Clinical Medicine,Xuzhou Medical University,Xuzhou 221004,China;Department of Neurology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China;Department of Neurology,the Affiliated Hospital of Weifang Medical College,Weifang 261031,China) |
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| Abstract: | Objective To explore the relationship between platelet to lymphocyte ratio(PLR),lipoprotein-associated phospholipase A2(Lp-PLA2),homocysteine(HCY)and the diagnosis and short-term prognosis of ischemic stroke.Methods A total of 200 cases of ischemic stroke patients(case group)admitted in the Department of Neurology of the Affiliated Hospital of Xuzhou Medical University from October 2018 to October 2019 were recruited as the case group.The 120 health people taking physical examination at the same time were enrolled as the control group.All the patients were test for PLR,Lp-PLA2 and HCY levels.The patients in the case group were divided into mild,moderate and severe neurological deficit groups according to NIHSS score at admission.After 3 weeks of treatment,the patients in the case group were divided into good prognosis group and poor prognosis group according to modified Rankin Scale(mRS)score.The levels of serum PLR,Lp-PLA2,HCY were compared among mild to moderate severe neurological deficits in the case group and between good prognosis group and poor prognosis group respectively.The ROC curve was used to analyze the diagnostic efficacy and evaluated the prognostic value.Results Compared with the control group,the levels of PLR,Lp-PLA2 and HCY were significantly higher in the case group,with statistical significance(168.73±62.12)vs(116.87±31.87),(245.64±81.30)μg/L vs(165.17±38.13)μg/L,(18.45±6.81)μmol/L vs(11.14±3.04)μmol/L;t=9.843,11.377,13.161;(P<0.05)].The results of binary logistic regression analysis showed that PLR,Lp-PLA2 and HCY were independent risk factors of ischemic stroke(OR=1.017,1.005,1.072;95%CI:1.009-1.026,1.000-1.010,1.009-1.139;P<0.01).The levels of PLR,Lp-PLA2 and HCY of mild,moderate and severe neurological deficit groups were significantly different(P<0.01).The follow-up results showed that the levels of PLR,Lp-PLA2 and HCY of the poor prognosis group were significantly higher than those of the good prognosis group 3weeks after discharge(204.75±65.08)vs(140.43±41.97),(282.99±77.49)μg/L vs(216.29±71.89)μg/L,(21.76±7.02)μmol/L vs(15.86±5.40)μmol/L],and the differences were statistically significant(t=8.048,6.293,6.716;P<0.05).The area under the curve of serum PLR,Lp-PLA2,HCY and combined diagnosis of ischemic stroke were 0.768,0.823,0.855 and 0.879,respectively(P<0.01).The area under ROC curve of serum PLR,Lp-PLA2 and HCY for short-term prognosis were 0.803,0.796 and 0.788 respectively.Conclusions The serum levels of PLR,Lp-PLA2 and HCY increased significantly in patients with ischemic stroke.The combined detection has high diagnostic efficiency,better clinical prognosis evaluation value,which can be a biological index for early prediction of ischemic stroke. |
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| Keywords: | Ischemic stroke Platelet to lymphocyte ratio Lipoprotein-associated phospholipase A2 Homocysteine Prognosis |
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